Vascular Surgery: An Essential Hospital Resource in Modern Health Care

Abstract

Objective: It has long been known that hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) broadly reduce cardiovascular events in patients with peripheral vascular disease. It was the goal of this study to determine if statin therapy significantly improves primary patency rates after stenting of superficial femoral and popliteal arteries.Methods: The records of all patients undergoing primary nitinol stenting of the femoral and popliteal arteries at a single institution and by a single surgeon during a 7-year period were reviewed. Patient demographics and risk factors were identified. TransAtlantic Inter-Society Consensus (TASC II) classifications were determined for all stented lesions to stratify severity of disease. Analysis was performed to determine whether the use of statins at the time of stent placement influenced patency. Loss of primary patency was said to have occurred when an intrastent occlusion or a 50% or greater stenosis was identified by arterial duplex ultrasound or angiography. Kaplan-Meier survival curves were plotted, and differences between groups were tested by log-rank method.Results: Between 2007 and 2014, primary femoral or popliteal stenting was performed on 162 limbs in 141 patients. At the time of intervention, 55.5% of these patients were being treated with statin therapy. There were 88 interventions performed for claudication and 74 for critical limb ischemia; 107 lesions treated were TASC A or B, and 55 were TASC C or D. Primary patency rates for all stented lesions was 68%, 53%, and 43% at 12, 24, and 36 months. Those taking statins had patency rates of 75%, 58%, and 47%, whereas the patency rates for those not taking statins were 55%, 45%, and 36% at 12, 24, and 36 months, respectively (P ¼ .179). Statins had no significant influence on patency rates when lesions were stratified for severity (TASC A/B, P ¼ .162; C/D, P ¼ .638). There was no significant difference in those treated for claudication or critical limb ischemia (P ¼ .929). Statin compliance was found to be 86% at a mean follow-up of 23.6 months.Conclusions: Whereas the use of statins has been shown to reduce cardiovascular morbidity and mortality in patients with peripheral vascular disease, the ability of these drugs to improve primary patency rates of patients after superficial femoral and popliteal artery stenting remains speculative.

Intraoperative Vascular Surgical Consultation during Non-Vascular Surgeries in Tertiary Centers by Vascular Surgeon

“…Because the history of vascular surgery in Korea is shorter than that in Western society, intraoperative consultation of vascular surgery has based on recanalization of vessel rather than reconstruction. Need of reconstruction, such as bypass or interposition, will increase like other studies [ 1 , 4 , 5 ].…”

A Multidisciplinary Approach to Oncological Resections with Vascular Surgeons Improves Patient Outcomes

“…Previous studies have suggested that the majority of vascular surgery involvement in intra-operative consultations is unplanned. 1,6,16 In a retrospective analysis of consecutive intra-operative consultations to vascular surgery for any operation type, including oncological resections, it was found that 56% of consultations were unplanned and that these unplanned consultations were most often for assistance with control of haemorrhage. 16 Pre-operative consultations were usually for planned vascular reconstruction.…”

“…1,6,16 In a retrospective analysis of consecutive intra-operative consultations to vascular surgery for any operation type, including oncological resections, it was found that 56% of consultations were unplanned and that these unplanned consultations were most often for assistance with control of haemorrhage. 16 Pre-operative consultations were usually for planned vascular reconstruction. In a separate series examining vascular surgery assistance during cancer operations, the authors reported that 52% of consultations were planned, and that planned consultations were associated with fewer vascular injuries, trends towards lower blood loss, and a higher rate of complete tumour resection.…”

“…Previous work describes that vascular surgeons may provide anatomical dissection, assistance in oncological resection, control of haemorrhage, repair of vascular injury or vascular reconstruction, and often perform a combination of all of these in oncological operations. 1,5,6,16 In this series of mostly planned collaborations, the role of anatomical dissection and exposure was that most often fulfilled by the vascular surgeon, and it is believed that this contributed to lowering the need for vessel repair and reconstruction, with a consequent reduction in blood loss. Limb amputation and endovascular techniques were also identified as other skills that may facilitate cancer operations, and this has not been described elsewhere.…”

“…5 Hence it is important to have vascular surgeons available in hospitals where complex oncological resections are performed. 16…”